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          <h1 class="post-title" itemprop="name headline">楔状缺损的直接修复，直接-间接修复和间接修复的流程</h1>
        

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        <p>第五节 树脂直接修复的技术流程<br>第一步 寻找病因解除<br>第二步 浮石粉清洁后比色(抛光膏也行吧？)<br>第三步 隔离(排龈或上障)<br>上障前局麻。<br>第四步 观察髓壁情况<br>第五步 洞底清洁干净<br>用锋利的挖匙去龋。<br>第六步 冠方边缘制备(斜面或浅凹形)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/01.png"><br>第七步 洞壁抛光硅胶尖(5000转/分，有水)<br>沿着冠方边缘延伸到近远中，龈壁不用抛光。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/02.png"><br>第八步 检查再次隔离(特氟龙)<br>特氟龙消好毒塞到楔缺近远中，隔离障布。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/03.png"><br>第九步 35%磷酸酸蚀釉质30s<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/04.png"><br>范围超过釉质边缘1MM。<br>完事先用强吸吸去酸蚀剂，再用流水冲。最后用水雾，与牙体长轴成60°角，不少于15s。冲洗的目的是去除酸与牙釉质反应产生的产物，盐。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/05.png"><br>第十步 自酸蚀处理剂摇匀，滴到瓶皿，处理牙本质15s2次，加压涂布，吹10s气流不用太大，粘接剂也涂两遍，固化40s<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/06.png"><br>第十一步 楔缺面积较大时可用流体底衬0.5mm分三层充填<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/07.png"><br>C因素=粘接面积/游离面积，如果大于1，树脂收缩较大。<br>圆凹面积较小分两层。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/08.png"><br>第十二步 抛光完成<br>1.阻氧固化40s<br>2.40μm粒度火焰状车针2万转修整飞边。<br>3.如果抛光时去除根方的牙本质，暴露牙骨质，会造成术后敏感。用12D刀片修整龈边缘。<br>4.硅胶尖5000转/分有水进行平整。<br>5.羊毛刷+A膏3000转无水1万有水，30秒后换B膏。<br>6.毛毡轮+C膏3000无水2万有水30s。<br>缺陷是太大了。<br>7.也可省略5，6，用FGM抛光工具抛光。<br>第七节 Newton-Fahl直接-间接修复技术<br>1.定义<br>①在酸蚀粘接前在口内堆塑并初步修型固化<br>②取下后在口外精修完成(为方便取下可在表面做一个树脂夹持柄，用持针器等取下)。<br>③在口内粘接完成。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/09.png"><br>2.起源<br>断冠再接<br>3.优势分析<br>①减少口内操作时间<br>②树脂修复体在口外可以热处理。<br>③树脂转化率高性能稳定。<br>④获得更好的边缘封闭和形态<br>⑤更好的抛光修型有利于牙周健康。<br>⑥患者舒适度高可多颗同时进行<br>4.技术流程<br>第一步 树脂选择:微填料树脂或纳米填料树脂<br>深度＞2.5mm建议本质釉质分层技术<br>第二步 窝洞制备<br>楔缺釉质边缘的预备(圆凹或斜面)<br>浅凹形缺损无需制备<br>第三步 窝洞充填<br>深度＞2.5mm建议本质釉质分层技术<br>有倒凹要处理(跟嵌体一样)，厚度大小比正常大0.2-0.3mm左右。<br>第四步 光固化，取下修复体<br>第五步 口外划线修形和抛光<br>用铅笔<br>修整前可对修复体再次固化<br>或者固化炉热固化7-9min<br>宁可少修不要多修。<br>第六步 粘接前修复体表面处理<br>27或50μm氧化铝距离1-2cm喷砂5s<br>35%-40%磷酸清洗喷砂后修复体(或超声荡洗)<br>涂布疏水粘接剂不固化避光保存。<br>第七步 粘接前牙面处理<br>27或50μm氧化铝距离1-2cm喷砂5s<br>32%磷酸酸蚀釉质30s本质10-15s<br>冲洗吸去多余水分保持本质微湿(冲洗完釉质用毛刷涂95%酒精，待其自然干燥)。<br>反复涂布粘接剂(AB3)两次。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/10.png"><br>轻吹散匀呈光亮薄膜状<br>固化40s(成膜厚度只有10μm，喷砂，树脂收缩等补偿，可以粘的。另外不固化填压可能导致胶原纤维网塌陷，小管液溢出等，固化以后就不会了。)<br>准备粘修复体<br>第八步 粘接修复体<br>选择加热的树脂或双固化水门汀均可。<br>在修复体上散匀树脂或水门汀<br>加压置入牙体就位初步清理<br>局部固化3秒<br>12d刀片清除颈部多余树脂水门汀<br>阻氧后循环固化40-60s。<br>第九步 完成抛光<br>与直接修复完全一致。<br>第八节 间接修复的流程<br>取模，二次印模法，局部托盘舌侧磨掉，只留合面和颊侧，从颊侧脱位。<br>加工方法用铸压式，别用CAD/CAM。<br>粘接<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/016/10.png"><br>较薄，最好不要超声荡洗</p>
<p>个人总结:NCCL修复主要有直接修复法，直接-间接修复法和间接修复法，过程主要有解除病因，清洁牙面，隔离，清洁窝洞，酸蚀，粘接，树脂分层充填，修整，抛光等。直接-间接修复法为在口内直接制作树脂嵌体，在口外修整后再粘接。间接修复法为取石膏模型后在口外制作瓷嵌体然后粘接。</p>
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